| NPI | 1770141715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0102206235) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102206235) |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2026-07-28 |